Organization
STANLEY LONG DBA HARBOR LIGHTS PROFESSIONAL CHEMICAL DEPENDENCY SERVIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANLEY E LONG (OWNER)
(315) 963-0777
Entity
Organization
Contact information
Practice address
3358 MAIN ST, MEXICO, NY 13114
(315) 963-0777
(345) 963-0611
Mailing address
PO BOX 716, 3358 MAIN ST, MEXICO, NY 13114
(315) 963-0777
(345) 963-0611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
080211024
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01463294
—
NY
Enumeration date
08/13/2006
Last updated
07/17/2008
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